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Global, regional, and national incidence, prevalence, and years lived with disability
for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic
analysis for the Global Burden of Disease Study 2017.

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Abstract

BACKGROUND:The Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD
2017) includes a comprehensive assessment of incidence, prevalence, and years lived
with disability (YLDs) for 354 causes in 195 countries and territories from 1990 to
2017. Previous GBD studies have shown how the decline of mortality rates from 1990
to 2016 has led to an increase in life expectancy, an ageing global population, and
an expansion of the non-fatal burden of disease and injury. These studies have also
shown how a substantial portion of the world's population experiences non-fatal health
loss with considerable heterogeneity among different causes, locations, ages, and
sexes. Ongoing objectives of the GBD study include increasing the level of estimation
detail, improving analytical strategies, and increasing the amount of high-quality
data. METHODS:We estimated incidence and prevalence for 354 diseases and injuries
and 3484 sequelae. We used an updated and extensive body of literature studies, survey
data, surveillance data, inpatient admission records, outpatient visit records, and
health insurance claims, and additionally used results from cause of death models
to inform estimates using a total of 68 781 data sources. Newly available clinical
data from India, Iran, Japan, Jordan, Nepal, China, Brazil, Norway, and Italy were
incorporated, as well as updated claims data from the USA and new claims data from
Taiwan (province of China) and Singapore. We used DisMod-MR 2.1, a Bayesian meta-regression
tool, as the main method of estimation, ensuring consistency between rates of incidence,
prevalence, remission, and cause of death for each condition. YLDs were estimated
as the product of a prevalence estimate and a disability weight for health states
of each mutually exclusive sequela, adjusted for comorbidity. We updated the Socio-demographic
Index (SDI), a summary development indicator of income per capita, years of schooling,
and total fertility rate. Additionally, we calculated differences between male and
female YLDs to identify divergent trends across sexes. GBD 2017 complies with the
Guidelines for Accurate and Transparent Health Estimates Reporting. FINDINGS:Globally,
for females, the causes with the greatest age-standardised prevalence were oral disorders,
headache disorders, and haemoglobinopathies and haemolytic anaemias in both 1990 and
2017. For males, the causes with the greatest age-standardised prevalence were oral
disorders, headache disorders, and tuberculosis including latent tuberculosis infection
in both 1990 and 2017. In terms of YLDs, low back pain, headache disorders, and dietary
iron deficiency were the leading Level 3 causes of YLD counts in 1990, whereas low
back pain, headache disorders, and depressive disorders were the leading causes in
2017 for both sexes combined. All-cause age-standardised YLD rates decreased by 3·9%
(95% uncertainty interval [UI] 3·1-4·6) from 1990 to 2017; however, the all-age YLD
rate increased by 7·2% (6·0-8·4) while the total sum of global YLDs increased from
562 million (421-723) to 853 million (642-1100). The increases for males and females
were similar, with increases in all-age YLD rates of 7·9% (6·6-9·2) for males and
6·5% (5·4-7·7) for females. We found significant differences between males and females
in terms of age-standardised prevalence estimates for multiple causes. The causes
with the greatest relative differences between sexes in 2017 included substance use
disorders (3018 cases [95% UI 2782-3252] per 100 000 in males vs s1400 [1279-1524]
per 100 000 in females), transport injuries (3322 [3082-3583] vs 2336 [2154-2535]),
and self-harm and interpersonal violence (3265 [2943-3630] vs 5643 [5057-6302]). INTERPRETATION:Global
all-cause age-standardised YLD rates have improved only slightly over a period spanning
nearly three decades. However, the magnitude of the non-fatal disease burden has expanded
globally, with increasing numbers of people who have a wide spectrum of conditions.
A subset of conditions has remained globally pervasive since 1990, whereas other conditions
have displayed more dynamic trends, with different ages, sexes, and geographies across
the globe experiencing varying burdens and trends of health loss. This study emphasises
how global improvements in premature mortality for select conditions have led to older
populations with complex and potentially expensive diseases, yet also highlights global
achievements in certain domains of disease and injury. FUNDING:Bill & Melinda Gates
Foundation.

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Assistant Professor of Environmental Health Science at Duke Kunshan University

My research interest is in the intersection of environment and population health.
Trained as an environmental epidemiologist, I am primarily interested in environmental
determinants of longevity. Second, given populations are living longer, how can we
delay neuro-degeneration and age-related diseases. Third, I am a proponent in applying
research for better policy-making to achieve SDG targets.